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A new long-term study published in BMJ Quality & Safety has found that understaffing of permanent ward nurses in hospitals is associated with longer patient stays, higher rates of readmission, increased risk of death, and greater overall costs to the healthcare system. The research, which analyzed data from over 626,000 patients across four NHS hospital trusts in England, highlights the critical importance of maintaining adequate levels of registered nurses (RNs) on inpatient wards.
Key Findings
The study, conducted between April 2015 and March 2020, revealed that patients on wards with insufficient RN staffing were more likely to experience negative outcomes:
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Mortality: 5% of patients on understaffed wards died, compared to 4% on adequately staffed wards.
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Readmissions: 15% of patients were readmitted within 30 days on understaffed wards, versus 14% on adequately staffed ones.
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Length of Stay: Patients stayed an average of eight days on understaffed wards, compared to five days with adequate staffing.
Each day a patient experienced RN understaffing in the first five days of their hospital stay, their risk of death increased by 8% and their risk of readmission by 1%. If all five days were understaffed, the length of stay increased by a striking 69%.
Similar trends were observed with nursing support staff (such as health care assistants), although the impact was slightly less pronounced.
Economic Impact and Cost-Effectiveness
The researchers calculated that eliminating understaffing for both RNs and support staff would cost an additional £197 per patient admission. However, this investment could prevent 6,527 deaths and add 44,483 years of healthy life during the study period. Factoring in reduced hospital stays, the net savings amounted to £4,728 per additional year of healthy life gained.
Importantly, the study found that using temporary agency staff to fill gaps was significantly less cost-effective, with costs per healthy year of life gained ranging from £7,320 to £14,639.
Policy Implications
The authors argue that efforts to rectify low staffing should not focus solely on the most acutely ill patients, as this is less effective and more costly. Instead, increasing the number of permanent RNs on general wards benefits all patients and is the most efficient use of resources.
They conclude, “There are no shortcuts to employing enough RNs, as using temporary staff is more costly and less effective.”
Study Limitations
The study is observational, meaning it cannot definitively establish cause and effect. Additionally, all data were drawn from English NHS hospitals, which may limit the generalizability of the findings to other healthcare systems. Staffing levels were assessed relative to ward norms rather than a validated measure of patient need.
Disclaimer:
This article summarizes findings from a peer-reviewed study published in BMJ Quality & Safety and reported by Medical Xpress. The study is observational and based on data from NHS hospitals in England; results may not be directly applicable to other healthcare settings. The information provided is for general informational purposes and should not be construed as medical or policy advice. For more details, consult the original study or a healthcare professional.
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